EKG

Lessons. Practice Strips and Drills

EKG Definition

An EKG, also called an ECG or electrocardiogram, records the heart's electrical activity. It is a quick and painless procedure.
EKGs capture information about the heart's electrical signal as it moves from the atrium (upper part of the heart) to ventricles (lower part of the heart).
These electrical signal cause the heart to contract and pump blood.
EKGs are interpreted by healthcare professionals to understand:

Heart rate

Heartbeat regularity

Strength and timing of the electrical signals

Any possible abnormal conditions

Introduction To EKG Training

This website provides a wide range of lessons, drills and quizzes designed to help medical professionals improve EKG knowledge and skills. The links below provide access to basic training lessons, to our reference guides well as to arrhythmia drills and quizzes.

EKG Interpretation - Introduction

This introductory interpretation training course reviews the main features of electrocardiogram strips. A method for analyzing an electrocardiogram is presented. This method includes assessment of rhythm, calculating heart rate, observing P-wave forms, measurement of wave intervals and segments and the evaluation of other relevant waves. In addition, our drills allow students to practice electrocardiogram identification.

EKG Practice Drills

EKG practice drills provide users with a quick and interactive method for learning arrhythmias. Users are asked to identify the arrhythmia and then receive immediate feedback after answering a multiple choice question. Tips for analyzing are used to interactively instruct each user. A directory of ekg strips is available.

ECG Quiz

Our quiz presents twenty tracings. Correct (and fast answers) earn quiz points. At the end of the quiz, your score is compared to mean and top scores for all recent website visitors. We also provide a graded report of your answers compared to correct responses. Quiz ekg tracings are randomly selected from our database of our 350 tracing, so that this quiz can be repeated many times while retaining its challenge.

Abnormal EKG Guide

Our Abnormal EKG reference guide provides information on over forty different arrhythmias. For each type of arrhythmia there are multiple examples, actual patient tracings and simulated electrocardiograms. We also provide an annotated tracing with a summary of the key features used in interpreting electrocardiograms. Interactive digital calipers can be used for measuring key features on each tracing.

12 Lead EKG

ECG Monitor Quiz (beta version)

Our Monitor Quiz is similar to the standard Quiz, but with a twist. Instead of static tracings, the ECGs are presented using a simulated patient monitor. After the twenty tracings are evaluated, we present a graded report along with static images of each tracing. Your score is compared to a mean score for all recent website visitors. Don't worry, your score is kept private.

How To Read An EKG - Lectures

Use EKG.Academy's library of free presentations on cardiac rhythms.
These training materials present the fundamentals for each major category of cardiac rhythms.
The fundamentals are reinforced with practice exercises throughout each lecture.

Abnormal EKG Types

A summary of each of the most common EKG types is provided below.

Accelerated Idioventricular Rhythm

The EKG rhythm will appear regular with heart rate that is
50-120 bpm. The P wave features:
absent. Observe that the PR interval is
not measurable. The QRS complex will typically be
wide (>0.10 sec), bizarre looking.
.

Accelerated Junctional Rhythm

The EKG rhythm will appear regular with heart rate that is
normal (60-100 bpm). The P wave features:
present before, during (hidden) or after qrs, if visible it is inverted. Observe that the PR interval is
not measurable. The QRS complex will typically be
normal (0.06-0.10 sec).
.

Asystole

The EKG rhythm will appear not present with heart rate that is
absent. The P wave features:
absent. Observe that the PR interval is
absent. The QRS complex will typically be
absent.
confirm with multiple leads.

Atrial Fibrillation

The EKG rhythm will appear irregular with heart rate that is
very fast (> 350 bpm) for atrial, but ventricular rate may be slow, normal or fast. The P wave features:
absent - erratic waves are present. Observe that the PR interval is
absent. The QRS complex will typically be
normal but may be widened if there are conduction delays.
.

Atrial Flutter

The EKG rhythm will appear regular or irregular with heart rate that is
fast (250-350 bpm) for atrial, but ventricular rate is often slower. The P wave features:
not observable, but saw-toothed flutter waves are present. Observe that the PR interval is
not measureable. The QRS complex will typically be
normal (0.06-0.10 sec).
.

Bundle Branch Block

The EKG rhythm will appear regular with heart rate that is
the underlying rate. The P wave features:
normal. Observe that the PR interval is
normal (0.12-0.20 sec). The QRS complex will typically be
wide (>0.12 sec).
.

First Degree Heart Block

The EKG rhythm will appear regular with heart rate that is
the underlying rate. The P wave features:
normal. Observe that the PR interval is
prolonged (>0.20 sec). The QRS complex will typically be
normal (0.06-0.10 sec).
a first degree av block occurs when electrical impulses moving through the atrioventricular (av) node are delayed (but not blocked). first degree indicates slowed conduction without missed beats..

Idioventricular Rhythm

The EKG rhythm will appear regular with heart rate that is
slow (20-40 bpm). The P wave features:
absent. Observe that the PR interval is
not measurable. The QRS complex will typically be
wide (>0.10 sec), bizarre appearance.
.

Junctional Escape Rhythm

The EKG rhythm will appear regular with heart rate that is
slow (40-60 bpm). The P wave features:
present before, during (hidden) or after qrs, if visible it is inverted. Observe that the PR interval is
not measurable. The QRS complex will typically be
normal (0.06-0.10 sec).
.

Junctional Tachycardia

The EKG rhythm will appear regular with heart rate that is
fast (100-180 bpm). The P wave features:
present before, during (hidden) or after qrs, if visible it is inverted. Observe that the PR interval is
absent or short. The QRS complex will typically be
normal (0.06-0.10 sec).
.

Multifocal Atrial Tachycardia

The EKG rhythm will appear irregular with heart rate that is
fast (> 100 bpm). The P wave features:
often changing shape and size from beat to beat (at least three differing forms). Observe that the PR interval is
variable. The QRS complex will typically be
normal (0.06-0.10 sec).
t wave is often distorted
also review wandering atrial pacemaker lesson.

Normal Sinus Rhythm

The EKG rhythm will appear regular with heart rate that is
normal (60-100 bpm). The P wave features:
normal (positive & precedes each qrs). Observe that the PR interval is
normal (0.12-0.20 sec). The QRS complex will typically be
normal (0.06-0.10 sec).
.

Pacemaker Failure to Capture

The EKG rhythm will appear irregular with heart rate that is
slow or normal. The P wave features:
. Observe that the PR interval is
. The QRS complex will typically be
.
pacemaker spikes are not followed by p waves or qrs complexes.

Pacemaker Failure to Pace

The EKG rhythm will appear irregular with heart rate that is
. The P wave features:
. Observe that the PR interval is
. The QRS complex will typically be
.
pacemaker spikes do not appear.

Pacemaker Single Chamber Atrial

The EKG rhythm will appear regular with heart rate that is
60 bpm. The P wave features:
normal. Observe that the PR interval is
normal. The QRS complex will typically be
normal.
.

Premature Atrial Complex

The EKG rhythm will appear irregular with heart rate that is
usually normal but depends on underlying rhythm. The P wave features:
premature, positive and shape is abnormal. Observe that the PR interval is
normal or longer. The QRS complex will typically be
0.10 sec or less.
.

Premature Junctional Complex

The EKG rhythm will appear regular with premature beats with heart rate that is
the underlying rate. The P wave features:
present before, during (hidden) or after qrs, if visible it is inverted. Observe that the PR interval is
absent or short. The QRS complex will typically be
normal (0.06-0.10 sec).
.

Premature Ventricular Complex

The EKG rhythm will appear irregular with heart rate that is
the underlying rate. The P wave features:
absent. Observe that the PR interval is
not measurable. The QRS complex will typically be
wide (> 0.10 sec), bizarre appearance.
two pvcs together are termed a couplet while three pvcs in a row with a fast rhythm is ventricular tachycardia.

Premature Ventricular Complex Bigeminy

The EKG rhythm will appear irregular with heart rate that is
the underlying rate. The P wave features:
absent. Observe that the PR interval is
not measurable. The QRS complex will typically be
wide (> 0.10 sec), bizarre appearance.
pvc appears every second beat.

Premature Ventricular Complex Quadrigeminy

The EKG rhythm will appear irregular with heart rate that is
the underlying rate. The P wave features:
absent. Observe that the PR interval is
not measurable. The QRS complex will typically be
wide (> 0.10 sec), bizarre appearance.
pvc appears every fourth beat.

Premature Ventricular Complex Trigeminy

The EKG rhythm will appear irregular with heart rate that is
the underlying rate. The P wave features:
absent. Observe that the PR interval is
not measurable. The QRS complex will typically be
wide (> 0.10 sec), bizarre appearance.
pvc appears every third beat.

Second Degree Heart Block Type I

The EKG rhythm will appear irregular but with progressively longer pr interval lengthening with heart rate that is
the underlying rate. The P wave features:
normal. Observe that the PR interval is
progressively longer until a qrs complex is missed, then cycle repeats. The QRS complex will typically be
normal (0.06-0.10 sec).
.

Second Degree Heart Block Type II

The EKG rhythm will appear regular (atrial) and irregular (ventricular) with heart rate that is
characterized by atrial rate usually faster than ventricular rate (usually slow). The P wave features:
normal form, but more p waves than qrs complexes. Observe that the PR interval is
normal or prolonged. The QRS complex will typically be
normal or wide.
.

Sinoatrial Block

The EKG rhythm will appear irregular when sa block occurs with heart rate that is
normal or slow. The P wave features:
normal. Observe that the PR interval is
normal (0.12-0.20 sec). The QRS complex will typically be
normal (0.06-0.10 sec).
pause time is an integer multiple of the p-p interval
try to identify specific type of atrial tachycardia - see other pages.

Sinus Arrest

The EKG rhythm will appear irregular due to pause with heart rate that is
normal to slow. The P wave features:
normal. Observe that the PR interval is
normal (0.12-0.20 sec). The QRS complex will typically be
normal (0.06-0.10 sec).
pause time is not an integer multiple of the p-p interval.

Sinus Arrhythmia

The EKG rhythm will appear irregular, varying with respiration with heart rate that is
normal (60-100 bpm) and rate may increase during inspiration. The P wave features:
normal. Observe that the PR interval is
normal (0.12-0.20 sec). The QRS complex will typically be
normal (0.06-0.10 sec).
heart rate frequently increases with inspiration, decreasing with expiration.

Sinus Bradycardia

The EKG rhythm will appear regular with heart rate that is
slow (< 60 bpm). The P wave features:
normal. Observe that the PR interval is
normal (0.12-0.20 sec). The QRS complex will typically be
normal (0.06-0.10 sec).
.

Sinus Tachycardia

The EKG rhythm will appear regular with heart rate that is
fast (> 100 bpm). The P wave features:
normal, may merge with t wave at very fast rates. Observe that the PR interval is
normal (0.12-0.20 sec). The QRS complex will typically be
normal (0.06-0.10 sec).
qt interval shortens with increasing heart rate.

Supraventricular Tachycardia

The EKG rhythm will appear regular with heart rate that is
fast (150-250 bpm). The P wave features:
merged with t wave. Observe that the PR interval is
normal (0.12 sec). The QRS complex will typically be
normal (.10 sec).
pr interval can be difficult to measure.

Third Degree Heart Block

The EKG rhythm will appear regular, but atrial and ventricular rhythms are independent with heart rate that is
characterized by atrial rate usually normal and faster than ventricular rate. The P wave features:
normal shape and size, may appear within qrs complexes. Observe that the PR interval is
absent: the atria and ventricles beat independently.. The QRS complex will typically be
normal, but wide if junctional escape focus.
.

Ventricular Fibrillation

The EKG rhythm will appear highly irregular with heart rate that is
unmeasurable. The P wave features:
absent. Observe that the PR interval is
not measurable. The QRS complex will typically be
none.
ekg tracings is a wavy line.

Ventricular Tachycardia

The EKG rhythm will appear regular with heart rate that is
fast (100-250 bpm). The P wave features:
absent. Observe that the PR interval is
not measurable. The QRS complex will typically be
wide (>0.10 sec), bizarre appearance.
.

Ventricular Tachycardia Monomorphic

The EKG rhythm will appear regular with heart rate that is
fast (100-250 bpm). The P wave features:
absent. Observe that the PR interval is
not measurable. The QRS complex will typically be
wide (>0.10 sec), bizarre looking.
.

Ventricular Tachycardia Polymorphic

The EKG rhythm will appear regular or irregular with heart rate that is
fast (100-300 bpm). The P wave features:
absent. Observe that the PR interval is
not measurable. The QRS complex will typically be
normal or wide (>0.10 sec), bizarre looking.
.

Ventricular Tachycardia Torsade de Pointes

The EKG rhythm will appear irregular with heart rate that is
fast (200-250 bpm). The P wave features:
absent. Observe that the PR interval is
not measurable. The QRS complex will typically be
wide (>0.10 sec), bizarre looking.
.

Wandering Atrial Pacemaker

The EKG rhythm will appear may be irregular with heart rate that is
normal (60-100 bpm). The P wave features:
changing shape and size from beat to beat (at least three diffferent forms). Observe that the PR interval is
variable. The QRS complex will typically be
normal (0.06-0.10 sec).
t wave normal. if heart rate exceeds 100 bpm, then rhythm may be multifocal atrial tachycardia (map).

Wolff-Parkinson-White Syndrome

The EKG rhythm will appear regular unless atrial fibrillation present with heart rate that is
normal (60-100 bpm). The P wave features:
normal. Observe that the PR interval is
can be short (<0.12 sec). The QRS complex will typically be
usually wide (> 0.12 sec).
look for short pr interval and/or delta wave
a delta wave (positive or negative) distorts the early part of the qrs complex.